@layout("/common/_form.html",{js:["/assets/btySuixingfu/btySuixingfu_add.js"],css:["/assets/expand/module/formSelects/formSelects-v4.css"]}){

<form class="layui-form" id="btySuixingfuForm" lay-filter="btySuixingfuForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <input name="id" type="hidden"/>

                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">店名<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="dm" name="dm" placeholder="请输入店名" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">营业日<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="yyr" name="yyr" placeholder="请输入营业日" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">门店编号<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="mdbh" name="mdbh" placeholder="请输入门店编号" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">支付金额<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="zfje" name="zfje" placeholder="请输入支付金额" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">退款金额<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="tkje" name="tkje" placeholder="请输入退款金额" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">到账金额<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="dzje" name="dzje" placeholder="请输入到账金额" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">手续费<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="sxf" name="sxf" placeholder="请输入手续费" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">支付方式<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="zffs" name="zffs" placeholder="请输入支付方式" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">0默认1成功<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="state" name="state" placeholder="请输入0默认1成功" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" ew-event="closeDialog">&emsp;取消&emsp;</button>
    </div>

</form>

@}